Session Information
Date: Tuesday, October 23, 2018
Session Title: Vasculitis – ANCA-Associated Poster II
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Granulomatosis with polyangiitis (GPA) is a systemic vasculitis with multi-organ involvement which can lead to frequent hospitalizations. Our study is to investigate characteristics and predictors of 30-day hospital readmission in GPA
Methods:
We used data from the National Readmission Database (NRD) for the year 2014. Diagnoses were identified by ICD-9 diagnosis code. Non-elective hospital admissions from January to November with a diagnosis of GPA (ICD-9 code 446.4) were included. Readmission was defined as hospital admissions within 30 days of discharge of a prior hospitalization. We studied characteristics of readmissions and non-readmissions. Mixed-effects multivariable logistic regression controlling for clustering of hospitals was performed to investigate the independent predictors for readmissions. To represent the national hospitalization data, analyses was accounted for the complex survey design and stratification of the data per NRD database sets.
Results:
A total of 9,119 hospital admissions with a diagnosis of GPA were identified in the year 2014. There were 2,173 readmissions within 30 days (23.8%). The top five primary diagnoses for readmissions were GPA (10.2%), sepsis (8.3%), pneumonia (5.8%), acute respiratory failure (2.6%) and acute kidney injury (AKI, 2.5%). Compared with non-readmissions, GAP readmissions were less likely to have private insurance (19% vs 26%, p < 0.001), more likely to have acute in-hospital events including acute respiratory failure (20% vs 18%, p = 0.021), sepsis (17% vs 15%, p = 0.009) and acute decompensated heart failure (10% vs 6%, p < 0.001), more likely to have chronic comorbidities including congestive heart failure (28% vs 20%, p < 0.001) and chronic kidney disease (62% vs 48%, p < 0.001), more likely to have higher hospital length of stay (8.0 vs 7.2 days, p = 0.019) and less likely to discharge home (50% vs 61%, p < 0.001) (Table 1). For GPA admissions, those who were readmitted within 30 days after discharge were more likely to be younger (OR = 0.99, p < 0.001), with higher Charlson Comorbidity Index (OR = 1.12, p = 0.044), have congestive heart failure (OR = 1.75, p = 0.001), develop AKI in the hospital (OR = 1.39, p = 0.006) and discharge to home health care (OR = 1.29, p = 0.041), and less likely to have private insurance (OR = 0.50, p < 0.001) (Table 2).
Conclusion:
There is a major burden of 30-day readmission among GPA patients. Predictors of readmissions include younger age, public insurance status, higher Charlson Comorbidity Index, heart and kidney complications and unfavorable discharge dispositions.
Table 1
|
Readmission |
Not a readmission |
P value |
|
|
Demographic characteristics |
|||
|
Age |
61 |
62 |
0.844 |
|
Gender (female) |
51% |
53% |
0.113 |
|
Primary payer |
|||
|
Medicare |
68% |
62% |
0.001 |
|
Medicaid |
10% |
8% |
0.493 |
|
Private |
19% |
26% |
< 0.001 |
|
Other |
3% |
4% |
0.291 |
|
Median income of patient ZIP code, state quartiles |
|||
|
First (lowest) |
23% |
20% |
0.112 |
|
Second |
25% |
27% |
0.358 |
|
Third |
26% |
25% |
0.52 |
|
Fourth |
26% |
28% |
0.283 |
|
Clinical characteristics of hospitalizations |
|||
|
Charlson Comorbidity Index |
2.67 |
2.25 |
< 0.001 |
|
Acute in-hospital events |
|||
|
Acute respiratory failure |
20% |
18% |
0.021 |
|
Pneumonia |
22% |
24% |
0.178 |
|
Sepsis |
17% |
15% |
0.009 |
|
Acute myocardial infraction |
2% |
3% |
0.208 |
|
Acute decompensated heart failure |
10% |
6% |
< 0.001 |
|
Acute kidney injury |
30% |
28% |
0.563 |
|
Chronic comorbidities |
|||
|
Hypertension |
19% |
25% |
< 0.001 |
|
Diabetes mellitus |
25% |
23% |
0.645 |
|
Coronary artery disease |
23% |
21% |
0.132 |
|
Congestive heart failure |
28% |
20% |
< 0.001 |
|
Obstructive lung disease* |
32% |
35% |
0.479 |
|
Interstitial lung disease |
5% |
5% |
0.606 |
|
Chronic kidney disease |
62% |
48% |
< 0.001 |
|
Chronic liver disease |
4% |
3% |
0.711 |
|
Cerebrovascular disease |
6% |
7% |
0.55 |
|
Mortality |
5% |
6% |
0.213 |
|
Length of stay |
8.0 |
7.2 |
0.019 |
|
Hospital cost |
19583 |
18478 |
0.289 |
|
Discharge disposition |
|||
|
Home |
50% |
61% |
< 0.001 |
|
Home health care |
22% |
17% |
< 0.001 |
|
Skilled nursing facility |
20% |
15% |
< 0.001 |
|
Other |
8% |
7% |
0.092 |
|
Hospital characteristics |
|||
|
Hospital location |
|||
|
Urban |
99% |
98% |
0.342 |
|
Rural |
1% |
2% |
|
|
Hospital teaching status |
|||
|
Teaching |
71% |
69% |
0.286 |
|
Non-teaching |
29% |
31% |
|
|
* Obstructive lung disease includes asthma, chronic obstructive pulmonary disease and bronchiectasis |
|||
Table 2
|
Adjusted odds ratio |
P value |
|
|
Demographic characteristics |
||
|
Age |
0.99 |
0.011 |
|
Gender (female) |
1.01 |
0.947 |
|
Primary payer |
||
|
Medicare |
reference |
|
|
Medicaid |
0.95 |
0.810 |
|
Private |
0.50 |
<0.001 |
|
Self-pay |
0.59 |
0.207 |
|
No charge |
0.70 |
0.565 |
|
Other |
1.01 |
0.980 |
|
Median income of patient ZIP code, state quartiles |
||
|
First (lowest) |
reference |
|
|
Second |
0.81 |
0.163 |
|
Third |
0.73 |
0.052 |
|
Fourth |
0.79 |
0.158 |
|
Clinical characteristics of hospitalizations |
||
|
Charlson Comorbidity Index |
1.12 |
0.044 |
|
Acute in-hospital events |
||
|
Acute respiratory failure |
1.10 |
0.514 |
|
Pneumonia |
0.86 |
0.243 |
|
Sepsis |
0.94 |
0.665 |
|
Acute myocardial infraction |
1.17 |
0.626 |
|
Acute decompensated heart failure |
0.76 |
0.212 |
|
Acute kidney injury |
1.39 |
0.006 |
|
Chronic comorbidities |
||
|
Hypertension |
1.21 |
0.192 |
|
Diabetes mellitus |
0.99 |
0.954 |
|
Coronary artery disease |
0.84 |
0.270 |
|
Congestive heart failure |
1.75 |
0.001 |
|
Obstructive lung disease* |
0.81 |
0.091 |
|
Interstitial lung disease |
1.65 |
0.062 |
|
Chronic kidney disease |
0.99 |
0.965 |
|
Chronic liver disease |
1.12 |
0.629 |
|
Cerebrovascular disease |
0.61 |
0.069 |
|
Discharge disposition |
||
|
Home |
reference |
|
|
Home health care |
1.29 |
0.041 |
|
Skilled nursing facility |
1.03 |
0.852 |
|
Left against medical advice |
1.63 |
0.317 |
|
Other |
1.18 |
0.683 |
|
Hospital characteristics |
||
|
Hospital location |
||
|
Urban |
reference |
|
|
Rural |
0.35 |
0.143 |
|
Hospital teaching status |
||
|
Teaching |
reference |
|
|
Non-teaching |
0.82 |
0.091 |
|
* Obstructive lung disease includes asthma, chronic obstructive pulmonary disease and bronchiectasis |
||
To cite this abstract in AMA style:
Luo Y, Jiang C, Arevalo Molina AB, Murray S, Salgado M, Xu J. 30-Day Hospital Readmission for Granulomatosis with Polyangiitis: Analysis from National Readmission Database [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/30-day-hospital-readmission-for-granulomatosis-with-polyangiitis-analysis-from-national-readmission-database/. Accessed March 28, 2023.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/30-day-hospital-readmission-for-granulomatosis-with-polyangiitis-analysis-from-national-readmission-database/